How to reduce a shoulder with scapular manipulation

Siamak Moayedi, MD
19th Nov 2020

The scapular manipulation technique is perfect for when you’re very busy and don’t have enough time to calm your patient down. 

 

How to reduce a shoulder with scapular manipulation

First, have your patient lay on a stretcher on their stomach, with their dislocated arm hanging down. You can leave them in this position for a while, and if they relax enough, sometimes the weight of the arm combined with relaxation will allow for spontaneous reduction of the shoulder. 

Preparing to reduce a shoulder with scapular manipulation: Patient with dislocated shoulder lying on stretcher with arm hanging. Cartoon.

Figure 1. Preparing to reduce a shoulder with scapular manipulation. Lay patient in prone on a stretcher with their dislocated arm hanging down. 

If you return and the shoulder is still out, then you can add the scapular manipulation technique:

  1. Find the bottom of the scapula.
  2. Slowly and gently push the scapula away from you. This should reposition the glenoid socket instead of moving the humeral head.
  3. Apply gentle downward traction on the arm. 
  4. Apply gentle internal and external rotation to overcome spasms.

Reducing a shoulder with scapular manipulation: Multicomponent image of clinician pushing scapula while assistant pulls down on forearm and applies internal/external rotation. Cartoon.

Figure 2. Reducing a shoulder with scapular manipulation. 1) Clinician places hands on the bottom, or inferior angle, of the scapula. 2) Clinician rotates the scapula to reposition the glenoid socket. 3) Assistant applies gentle downward traction. 4) Gentle internal and external rotation can be applied to overcome muscle spasms.   

The reduction can be very subtle, so you may need to re-examine the shoulder intermittently.

 

How to select the right patient for scapular manipulation

Keep in mind, this technique is not necessarily safe if you need to administer a sedative. It’s hard to manage the airway of a patient that’s laying on their chest, and there is a risk of the patient falling off the stretcher. Choose your patients wisely when using this technique.

Selecting the right patient for the scapular manipulation: Anxious female patient beside a calm male patient. Cartoon.

Figure 3. Selecting the right patient for scapular manipulation. 

Great work! You’ve now covered the summary for performing the scapular manipulation technique. 

 

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Recommended readings

  • Alkaduhimi, H, van der Linde, JA, Willigenburg, NW, et al. 2017. A systematic comparison of the closed shoulder reduction techniques. Arch Orthop Trauma Surg137: 589–599. PMID: 28251280
  • Cunningham, N. 2003. A new drug free technique for reducing anterior shoulder dislocations. Emerg Med (Fremantle)15: 521–524. PMID: 144992071
  • Marinelli, M, de Palma, L. 2009. The external rotation method for reduction of acute anterior shoulder dislocations. J Orthop Traumatol10: 17–20. PMID: 19384630
  • Sayegh, FE, Kenanidis, EI, Papavasiliou KA, et al. 2009. Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods. J Bone Joint Surg Am91: 2775–2782. PMID: 19952238
  • Stafylakis, D, Abrassart, S, and Hoffmeyer, P. 2016. Reducing a shoulder dislocation without sweating. The Davos technique and its results. Evaluation of a nontraumatic, safe, and simple technique for reducing anterior shoulder dislocations. J Emerg Med50: 656–659. PMID: 26899512